What are the responsibilities and job description for the Appeals and Grievance Specialist II | Irving, TX | Onsite | Contract position at Walker Healthforce?
Job Details
Appeals and Grievance Specialist II | Irving, TX | Onsite | Contract
Walker Healthforce is seeking an Appeals and Grievance Specialist II for a healthcare client located in Irving, TX. This is a contract opportunity.
Start Date: ASAP
Walker Healthforce Standard Perks:
JOB DESCRIPTION
JOB REQUIREMENTS
PREFERRED JOB REQUIREMENTS
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
#IND1
Walker Healthforce is seeking an Appeals and Grievance Specialist II for a healthcare client located in Irving, TX. This is a contract opportunity.
Start Date: ASAP
Walker Healthforce Standard Perks:
- Weekly pay via Direct Deposit
- Medical, Dental, and Vision Available
- 401K
JOB DESCRIPTION
- Review and resolve inquiries and complaints from members and providers related to claims, denials, benefits, and appeals.
- Review, classify, research, and resolve grievances and appeals within CMS-required timeframes.
- Communicate resolutions professionally to members or their authorized representatives.
- Coordinate with internal departments to ensure the effective execution of decisions.
- Ensure full compliance with CMS regulations, TRICARE requirements, and Company Health Plan policies and procedures.
- Analyze data from grievances and appeals to identify trends, root causes, and opportunities for improvement.
- Prepare and deliver tracking and trending reports regularly.
- Recommend and support the implementation of process improvements to enhance member satisfaction and operational efficiency.
- Educate members and providers about appeal and grievance processes, benefit coverage, and relevant plan information.
- Certify accurate reimbursement to providers and members per Medicare reimbursement rules and policies.
JOB REQUIREMENTS
- 5 years of experience in healthcare customer service with exposure to claims, denials, appeals, and compliance
- Proficient in Microsoft Office Suite, especially Excel and Word
- Proven experience reviewing, researching, and resolving member complaints and appeals per CMS/TRICARE guidelines and communicating resolutions to members or their authorized representatives
- Strong understanding of CMS regulations and the ability to meet 95% compliance standards by adhering to federal and state regulations and internal procedures
- Familiarity with CPT and ICD coding
PREFERRED JOB REQUIREMENTS
- Bachelor’s Degree in Healthcare Administration, Nursing, Health Information Management, or a related
- CPC or similar coding certification
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
#IND1
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
